By the end of this unit, students will be able to: Identify the need for prior authorization across a variety of medical services and payer plans. Complete a pre-certification request accurately, ensuring that all required information is included to facilitate approval. Analyze payer-specific authorization requirements and adjust workflows to accommodate different insurers’ needs. Evaluate and resolve common causes of pre-authorization denials, implementing strategies to improve claim acceptance rates. Apply pre-authorization workflows to real-world scenarios, improving efficiency and minimizing the time spent on administrative tasks.

Completion of Unit 2.2 (Insurance Eligibility and Verification). Basic familiarity with CPT, HCPCS, and ICD-10 codes, and payer communication systems.

Patient Access and Pre-Certification Specialists Clinical Authorization Coordinators and Referral Coordinators Billing and Utilization Review Staff Revenue Integrity and Denial Prevention Teams Healthcare Administration and HIM Students seeking operational RCM roles